Objective: To assess the energy and nutrient adequacy of a variety of complementary foods used in parts of Africa, India, Papua New Guinea, the Philippines and Thailand. Method: The energy, nutrient and anti-nutrient (dietary ®bre and phytic acid) content (per 100 g as eaten, per 100 kcal, and per day) of twenty-three plant-based complementary foods consumed in developing countries was calculated from food composition values based on chemical analysis for the trace minerals, non-starch polysaccharide and phytic acid, and the literature. Results were compared with the estimated nutrient needs (per day; per 100 kcal) from complementary foods for infants 9±11 months, assuming a breast milk intake of average volume and composition and three complementary feedings per day, each of 250 g. Results:Complementary foods should provide approximately 25±50% of total daily requirements for protein, ribo¯avin and copper; 50±75% for thiamin, calcium and manganese; and 75±100% for phosphorus, zinc and iron. Most or all appear to meet the estimated daily nutrient needs (per day; per 100 kcal) from complementary foods for protein, thiamin and copper (per day), but not for calcium, iron, and in some cases zinc, even if moderate bioavailability for iron and zinc is assumed. Some of those based on rice are also inadequate in ribo¯avin (per day; per 100 kcal). Conclusions: Even if strategies to improve the bioavailability of iron and zinc are employed, they are probably insuf®cient to overcome the de®cits in calcium, iron and zinc. Therefore, research on the feasibility of fortifying plant-based complementary foods in developing countries with calcium, iron and zinc is urgently required. Sponsorship: This study was supported by the Micronutrient Initiative through the Canadian International Development Agency.

Objective: The objectives of this study were to estimate the quantity and nutritive quality of the complementary diet in rural Malawi, and to identify feeding practices, nutrients and dietary modifiers of iron and zinc bioavailability that may limit the quality of the diet. Design: This cross-sectional study design included an anthropometric survey, a feeding practices questionnaire, and an interactive, 24 h recall dietary data survey. Setting: Four rural villages in Balaka district, southern Malawi. Subjects: Mothers resident in the study communities with breastfed children aged up to 24 months were eligible. Results: Stunting was prevalent among these weanlings. Maize was the predominant food source, with limited contribution of animal foods. Deficits in dietary energy and several nutrients were found when compared to estimated needs. When expressed per kg body weight, energy intakes appeared adequate. The bioavailability of zinc was low due to a high phytate:zinc molar ratio. Iron bioavailability was also low due to low intake of absorption enhancers such as meat=fish=poultry protein and ascorbic acid. Dietary quality was poorest for 6 to 8-month-old infants. Conclusions: Iron, zinc and calcium were the most limiting nutrients to the quality of the diet, partly exacerbated by the poor bioavailability of iron and zinc. Increased total intake and bioavailability of iron and zinc would improve the complementary diets.

Objective: To assess whether persistent micronutrient deficiencies in Mongolian children identified in our earlier biochemical study are associated with inadequacies in quantity and/or quality in their complementary diets. Design: A cross-sectional study of breast-fed children aged 6-23 months, randomly selected from four districts in Ulaanbaatar and four provincial capitals. Subjects: Weight and length were measured, and sociodemographic status, feeding practices and nutrient adequacy of complementary foods for children aged 6-8 months (n 26), 9-11 months (n 29) and 12-23 months (n 73) were assessed via questionnaire and in-home interactive 24 h recalls. Results: No geographic differences existed so data were combined. Adherence to WHO infant and young child feeding practices was poor: few children were exclusively breast-fed up to 6 months of age or received the recommended number of feedings containing the recommended number of food groups. Nevertheless, energy intakes from complementary diets, primarily from cereals and non-nutritious snacks, were above WHO-estimated needs; ,1 % of energy was from meat and eggs or fruits and vegetables. Median intakes and densities of most nutrients (except protein, thiamin and riboflavin) failed to meet WHO recommendations for at least two age groups, assuming average breast milk intake; greatest density deficits were for Fe . vitamin C . vitamin A . Zn . Ca. Conclusions: Complementary feeding in Mongolia is compromised by deficits in several micronutrients but not energy, in part because of frequent consumption of non-nutritious snacks. The latter may interfere with breast-feeding and should be avoided. Instead, wheat-based complementary foods should be enriched with affordable cellular animal foods and fruits rich in vitamin C to combat existing micronutrient deficits.

The importance of coexisting micronutrient defi ciencies in developing countries is gaining recognition, prompted by the disappointing responses often observed with single micronutrient supplements. Further, of concern is the feasibility and sustainability of supplementation as a mode of delivery in poor resource settings. Consequently, there is increasing emphasis on food-based approaches: fortifi cation, dietary diversifi cation and modifi cation, and biofortifi cation. Novel delivery approaches exist for fortifying complementary foods in the household using tablets, sprinkles and fat-based spreads. These are all designed to supply micronutrients without any changes in feeding practices, and irrespective of the amount of food consumed. A version of the fortifi ed spread is also used as a ready-to-use therapeutic food for treating malnourished children. Dietary diversifi cation and modifi cation, in conjunction with nutrition education, focuses on improving the availability, access to and utilization of foods with a high content and bioavailability of micronutrients throughout the year. The strategies are designed to enhance the energy and nutrient density of cereal-based porridges; increase the production and consumption of micronutrient-dense foods (especially animal-source foods); incorporate enhancers of micronutrient absorption; and reduce the phytate content of cereals and legumes through germination, fermentation and soaking. In the future, biofortifi cation via processes such as agronomic practices, conventional plant breeding or genetic modifi cation holds promise as a sustainable approach to improve micronutrient adequacy in the diets of entire households and across generations in developing countries. This review summarizes new developments in food-based approaches, their advantages and limitations, and examines some of the effi cacy studies and programmes utilizing food-based strategies to alleviate micronutrient defi ciencies.

The relation between zinc status and cognitive function was examined in a cross-sectional study in the Sidama area of Southern Ethiopia. Pregnant women >24 weeks of gestation from three adjacent rural villages volunteered to participate. Mean (s.d.) plasma zinc of 99 women was 6.97 (1.07) μmol/l (below the cutoff of 7.6 μmol/l indicative of zinc deficiency at this stage of gestation). The Raven’s Coloured Progressive Matrices (CPM) test was administered individually. Scores for the Raven’s scale A, which is the simplest scale, ranged from 4 to 10 of a possible 12. Women with plasma zinc <7.6 μmol/l had significantly lower Raven’s CPM scale A scores than women with plasma zinc concentrations >7.6 μmol/l. Plasma zinc and maternal age and education predicted 17% of the variation in Raven’s CPM scale A scores. We conclude that zinc deficiency is a major factor affecting cognition in these pregnant women.